EFFECTS OF ACTIVE HCV REPLICATION ON NEUROLOGIC STATUS IN HIV RNA VIRALLY SUPPRESSED PATIENTS

To the Editor:

We read with interest the article by Clifford et al.,¹ who conducted a retrospective study of neurocognitive deficits and peripheral neuropathy in subjects with stable, treated HIV infection and active hepatitis C infection (HCV).

The authors compared the subjects using the Trail-Making A and B tests and the Wechsler Adult Intelligence Scale–Revised (WAIS-R) digit symbol test. No significant differences between groups were observed, which led authors to conclude that active HCV infection does not affect neurocognitive function in subjects with optimally controlled HIV infection. However, additional factors may have influenced results.

Evaluating neurocognitive dysfunction in chronic HCV is challenging and the assessment tools used by Clifford et al. may have been suboptimal. Studies that have demonstrated cognitive differences between viremic HCV-positive and HCV-negative individuals have utilized extensive batteries of cognitive tests that have assessed performance of cognitive domains individually and with high precision.^2,3

It has been shown that there is executive function impairment in HCV-positive individuals with minimal or absent HCV-related liver disease.^2,3 Using less detailed tools may lead to inadequate findings. Córdoba et al.⁴ concluded that their use of noncomputerized assessments with inferior sensitivity may have …